Change can be uncomfortable, and although it is sometimes welcome and taken in stride, it is not uncommon for new ideas, approaches, and designations to have unexpected ripples and generate feedback. In this issue we include several articles highlighting changes in healthcare and novel ideas that can have a significant impact on providers and their patients.

Patients often select their pharmacy based on its close proximity to their home or place of work, whether their insurance is accepted (eg, costs), its appearance, and whether their customer service is satisfactory. Community pharmacists focus on dispensing prescriptions accurately, following applicable laws, and providing excellent customer service. These axioms were taught to me in pharmacy school by Professor Amadio nearly 40 years ago, and largely remain true today. In a recent announcement, the National Association of Specialty Pharmacy (NASP) defines specialty pharmacy and specialty medications in a way that could impact these axioms in the future.

Since 2010, the Affordable Care Act (ACA) has been rapidly changing the healthcare system in the United States. This transformation is occurring because of broadening healthcare insurance coverage, which in turn opens publicly and privately provided care to millions of Americans.

Multiple chronic diseases and conditions, including diabetes, cardiovascular disease, obesity, and depression, are associated with insufficient sleep. More than a quarter of Americans occasionally do not get enough sleep, and approximately 10% experience chronic insomnia. However, new methods for assessing and treating sleep disorders are bringing hope to the millions of people with inadequate sleep. The following sleep hygiene tips may be useful for promoting regular sleep and improving your sleep habits.

Hepatitis C virus (HCV) is a ribonucleic acid (RNA) virus with ≥6 known genotypes, and >50 subtypes. Genotype 1 is the most common worldwide. HCV infection is prevalent, with an estimated 130 million to 175 million patients chronically infected worldwide; the disease affects approximately 4 million people in the United States.

Accountable care is transforming healthcare in the United States. Accountable care organizations (ACOs) move away from a volume-driven system—where providers are paid a fee for service—to a value-driven system, where providers are incented to keep people well, and achieve high-quality, low-cost outcomes. Although conversion to a value-driven system will take some time, the early majority of ACOs are already refining models and allocating roles for various care providers in the new system.

The Case: An elderly man with a history of arthritis, benign prostatic hypertrophy with urinary obstruction, hyperlipidemia, obesity, and a long history of tobacco use presented to a local emergency department for chest pain. An electrocardiogram revealed a new anterior myocardial infarction, and a cardiac catheterization confirmed single-vessel disease isolated to the left anterior descending artery. The resulting percutaneous coronary intervention resulted in the placement of 2 drug-eluting stents. After stent placement, the patient was placed on triple anticoagulation therapy consisting of warfarin, clopidogrel (Plavix), and aspirin.